Provider Demographics
NPI:1225807258
Name:BAKER, STACY (LICSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 MAIN STREET
Mailing Address - Street 2:PO BOX 8
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-9172
Mailing Address - Country:US
Mailing Address - Phone:802-222-3000
Mailing Address - Fax:
Practice Address - Street 1:4628 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-9172
Practice Address - Country:US
Practice Address - Phone:802-222-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01355881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical